CRST Expedited

**** **** ****** **

Cedar Rapids, IA 52404

800-***-****

**-**-**** *:06:02PM CST

IntelliApp

Personal Information

Referral Code: JamieMartin

Name Glenn B Wiley

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

Current Address 6341 12th Ave

Address 2 6341 12th Ave

City, State/Province Zip/Postal Kenosha, WI 53143

Country United States

SSN/SIN 3947

Date of Birth

Primary Phone 312-***-****

Preferred method of contact Cell Phone

Best time to contact you Any

Email acyezi@r.postjobfree.com

How did you hear about us? Other - Job search online Yes, I want to receive information and

communications from CRST Expedited

concerning future opportunities or

promotions.

Yes

Yes, I want to receive text messages from

CRST Expedited. *By participating, you

consent to receive text messages sent by

an automatic telephone dialing system.

Consent to these terms is not a condition

of hire. You may opt out at any time by

texting STOP to unsubscribe. Message

and Data Rates May Apply.

Yes

Company Questions

By my signature at the end of this

application, I confirm that I have read

the Consumer Reports Disclosure and

Authorization Documents.

Yes

1

OVER-THE-ROAD DRIVER JOB DESCRIPTION

An over-the-road driver must be able to pick up, transport and deliver product in a safe, professional, courteous and timely manner, driving a semi-tractor in the contiguous 48 states, with up to a 53' trailer.

The driver is the single direct contact responsible for good public relations with the motoring public and with existing and prospective clients and customers. The driver must be able to communicate orally and in writing with others including company representatives, fellow drivers, and customers. The driver must be able to read, write and do basic math to properly complete bills of lading, tripsheets, logs, accident, and cargo claims paperwork. The driver must be able to read and understand maps. The driver must know and understand Department of Transportation rules and regulations pertaining to over-the-road drivers, equipment, and cargo listed in the Federal Motor Carrier Safety Regulations. The driver must understand and comply with company policies and procedures.

The driver must have a basic mechanical knowledge of a tractor/trailer. The driver must be able to perform DOT equipment inspections, hook/unhook trailers, and enter and exit the tractor and trailer. The driver must be able to shift manual transmission engines, control the steering wheel, operate the brake and accelerator pedals, and be able to back and park a tractor-trailer unit.

The driver must have a long history of honesty; display safe behaviors at all times and have the ability to get along with others. Felony convictions involving safety, drugs or alcohol, or crimes against persons may disqualify you from consideration for a driving position with CRST.

The driver must meet DOT standards for physical exam, drug test, and commercial drivers' license as well as company standards.

The driver must be able to drive up to a 10 hour shift and up to 70 hours per week. In the coast-to-coast team operation, the driver must work effectively with their co-driver to perform their job responsibilities while working relatively long hours and performing repetitive work in a tractor. This may require the driver to be away from home 21 days or more at a time, work with variable work/rest cycles due to frequent deadlines and meeting delivery schedules, be exposed to environmental extremes, and encounter day-to-day stressful situations.

Drivers on occasion must load and unload trailers handling weights of up to 75 pounds and be able to mount snow chains on tires. Drivers may be required to use loading/unloading devices such as electric floor jacks and hand dollies. This job description is intended to accurately state the working conditions and the tasks that must be performed for this job. However, the description is not an exhaustive list and the driver may be required to perform other tasks or other work from time to time as assigned to the driver by his supervisor or management. Have you reviewed the job description

above?

Yes

Do you understand the requirements? Yes

Can you perform the requirements of this

job with or without reasonable

Yes

OVER-THE-ROAD DRIVER JOB DESCRIPTION 2

accommodation?

General Information

How did you hear about CRST? Internet Ad

Please be specific (i.e., if from a magazine,

put the magazine name here):

Online

Were you referred by a CRST Driver? No

Please list the CRST Employee's name,

terminal and ID#, if you have it:

If you have spoken with a CRST recruiter,

please select his/her name:

Jamie Martin

CRST Position Descriptions

• Company Driver: Student and Experienced Drivers interested in joining CRST.

• Lease Purchase: Drivers interested in CRST's lease purchase program.

• Owner Operator: Owner Operators interested in joining CRST. What type of position are you applying for? Company Driver Have you recently graduated from a

trucking school? If yes, list the school and

date of graduation, length of trailer, and

transmission type.

No

Have you ever been known by any other

name?

Yes

List all names: Main

Can you speak English? Yes

Can you read English? Yes

Can you write English? Yes

Can you legally work in the United States? Yes

How many years have you had a valid

driver's license?

22 years

License and MVR Information

Have you ever been refused liability

insurance?

No

If you answered Yes to any of the above

questions, please give details; otherwise,

enter NONE:

None

Are you currently an ACTIVE service

member in National Guard, Reserve or

Active Duty for any branch of the armed

services?

No

Do you have PREVIOUS military

experience?

No

General Information 3

Do you have 6 months of Over The Road

(OTR) experience within the last year?

No

Based on your answer of having OTR

experience, are you interested in driving as

a Lease Purchase driver?

Licenses

Please enter all licenses you have held in the past. License Number 129

State/Province IL

Country United States

License Class

License Expiration Date 05-05-2017

Physical Expiration Date 05-05-2017

Current License Yes

Commercial Driver License No

Endorsements None

Employment / Unemployment

Unemployment

Start Date 11-2016

End Date 01-2017

Comment

Unemployment

Start Date 11-2016

End Date 01-2017

Comment

Unemployment

Start Date 04-2016

End Date 10-2016

Comment

Unemployment

Start Date 01-2014

End Date 03-2016

Comment

License and MVR Information 4

Unemployment

Start Date 10-2014

End Date 07-2015

Comment

Unemployment

Start Date 04-2014

End Date 09-2014

Comment

Fair oaks farm

Company Fair oaks farm

Start Date 04-2010

End Date 11-2012

Address 6341 12th ave

Address 2 6341 12th Ave

City, State/Province Zip/Postal Kenosha, WI 53143

Country United States

Phone 312-***-****

Position Held Forklift operator

Reason for leaving? Quit

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

No

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer

License and MVR Information 5

Trailer length

Simplified Staffing

Company Simplified Staffing

Start Date 07-2012

End Date 11-2012

Address 6341 12th ave

Address 2 6341 12th Ave

City, State/Province Zip/Postal Kenosha, WI 53143

Country United States

Phone 262-***-****

Fax 262-***-****

Position Held Material handling

Reason for leaving? Laid off

Were you terminated/discharged/laid off? Yes

Termination Explanation Laid off

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

No

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer

Trailer length

Jernbern industrial steelmill

Company Jernbern industrial steelmill

Start Date 05-2004

End Date 10-2009

License and MVR Information 6

Address 6341 12th ave

Address 2 6341 12th Ave

City, State/Province Zip/Postal Kenosha, WI 53143

Country United States

Phone 312-***-****

Position Held Machine operator

Reason for leaving? Laid off

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

No

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer

Trailer length

Ace Staffing

Company Ace Staffing

Start Date 02-2002

End Date 03-2003

Address 6341 12th ave

Address 2 6341 12th Ave

City, State/Province Zip/Postal Kenosha, WI 53143

Country United States

Phone 386-***-****

Fax 352-***-****

Position Held Material handling

License and MVR Information 7

Reason for leaving? Fired

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

No

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer

Trailer length

Motor Vehicle Record

1. Has any license, permit or privilege ever

been denied, suspended or revoked for

any reason?

No

2. Have you ever been convicted of driving

during license suspension or revocation, or

driving without a valid license or an expired

license, or are any charges pending?

No

3. Have you ever been convicted for any

alcohol or controlled substance related

offense while operating a motor vehicle, or

are any charges pending?

No

4. Have you ever been convicted for

possession, sale or transfer of an illegal

substance (including but not limited to,

marijuana, amphetamines, or derivatives

thereof) while on duty, or are any charges

pending?

No

5. Have you ever been convicted of

reckless driving, careless driving or

careless operation of a motor vehicle, or

are any charges pending?

No

License and MVR Information 8

6. Have you ever tested positive, or

refused to test on a pre-employment drug

or alcohol test by an employer to whom

you applied, but did not obtain

safety-sensitive transportation work

covered by DOT agency drug and alcohol

testing rules in past three years, or have

you ever tested positive or refused to test

on any DOT-mandated drug or alcohol

test?

No

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?

No Accidents

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 3 years? No Violations

Criminal Record

Have you ever been convicted of a crime? Yes

Comment Felony possession

Do you have any deferred prosecutions? No

Do you have criminal charges pending? No

Have you ever pled "guilty" to, been

convicted of, or pled "no contest" to a

felony?

Yes

Comment Probation and I completed it

If you have any felony convictions, do you

currently hold a minister's permit to enter

or exit Canada?

No

Have you ever pled guilty to, been

convicted of, had prosecution deferred in

connection with, or pled no contest to a

misdemeanor?

Yes

Comment Possession

License and MVR Information 9

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I

have read and understand the Summary of

Rights.

Yes

Drug and Alcohol Release

I agree with the above language Yes

Certification Release

I agree with the above language Yes

PSP Release

I agree with the above language Yes

User Requested Copy

User requested a copy to be sent to this

email address acyezi@r.postjobfree.com.

Yes

By my check of this box, I represent that I

understand and agree to the above and

that I intend to execute this document by

electronic signature in checking this box.

Yes

Signature

Full Name Glenn B Wiley

IP Address 75.86.162.231

Signature Date/Time 01-16-2017 8:05 PM

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signed Date: 01-16-2017 8:05 PM

Signed:

License and MVR Information 10

License and MVR Information 11

TO BE READ AND SIGNED BY APPLICANT

This application for employment and any resulting conditional job offer or contract of hire shall be deemed to be completed and executed in the state of Iowa.

It is agreed and understood that any misrepresentations of any information by applicant shall be considered an act of dishonesty and may subject applicant to immediate discharge if hired.

It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, including all information on my Alcohol and Controlled Substance Testing/Training Records, whether same is of record or not, and applicant releases former and/or current employers named herein from all liability for any damages for furnishing such information. It is understood that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by the motor carrier safety regulations. I further release and agree to hold harmless any previous or current employer as well as any employee, agent, or representative thereof from all liability of damage that may arise from the release of these results. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

(MA) - An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file with the commissioners of probation may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.

(PA) - I authorize my employer to obtain from the Registry of Motor Vehicles a copy of my Motor Vehicle Violations Record. It is understood that this application for employment and any conditional offer of employment in no way obligates the employer to employ me, and it is understood that, if hired, my employment is "at will." The terms of my at-will employment can only be changed by written contract, signed by an officer of CRST.

I agree that any compensation as a result of a worker compensation injury or illness shall be governed by and paid according to the benefits schedule provided by the state of Iowa.

It is agreed that the applicant, by presenting the application for employment, represents that the statements given by the applicant to the information requested in the application are true, correct and complete, and that any false, misleading or incomplete statements of the information requested in this application shall be sufficient grounds for discharge if employed. It is agreed and understood that as a condition of employment, all drivers will be subject to drug/alcohol testing and a physical examination. I affirm that I have a genuine interest and no other purposes in applying for a job with the company. I hereby certify I possess only a driver's license for the state of my residence and have returned all other(s) I may have possessed to the state(s) of issuance.

FMCSA Notification of Driver Rights

Under 49 CFR 391.23, you have the following rights regarding your employment history as a Department of Transportation regulated employee as the driver of a commercial motor vehicle or as someone employed in a safety-sensitive function that required alcohol and drug testing as specified by 49 CFR 40, as that information is provided by previous employers to CRST as a prospective employer under this regulation:

• you have the right to review information provided by previous employers; you have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to prospective employers; and

•

you have the right to have a rebuttal statement attached to the alleged erroneous information, if one of your previous employers and you cannot agree on the accuracy of the information

•

If you have previous DOT regulated employment history in the three years preceding your application to CRST and wish to review previous employer-provided investigative information, you must submit a written request to CRST. This may be done at any time, including when applying to CRST, but no later than 30 days after being employed by CRST or being notified of denial of employment by CRST. CRST will provide the requested information to you within five business days of receiving the written request. If CRST has not yet received the requested information from your previous employer, then the five day deadline will begin when the requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within 30 days of CRST making the records available to you, CRST may consider you to have waived your request to review the records.

FMCSA Notification of Driver Rights 12

Printed Name:

Glenn B Wiley

Social Security #:

3947

Signed Date: 01-16-2017

Glenn B Wiley

6341 12th Ave

6341 12th Ave

Kenosha, WI 53143

312-***-****

Gender:

FMCSA Notification of Driver Rights 13

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with CRST ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize CRST ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Printed Name:

Glenn B Wiley

Signed Date: 01-16-2017

FMCSA Notification of Driver Rights 14

TO BE READ AND SIGNED BY APPLICANT

I AUTHORIZE WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC AND/OR HIRERIGHT TO FURNISH THE ABOVE-MENTIONED INFORMATION WITH REGARD TO THIS APPLICATION FOR EMPLOYMENT. I have a right to make a request to DAC and/or HireRight, upon proper identification, of the nature and substance of all information provided with regard to the undersigned; and the names of the recipients of any reports about me which DAC and/or HireRight has previously furnished within the two-year period preceding my employment. I hereby authorize procurement of consumer report(s). If hired or contracted, this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period. Printed Name: Glenn B Wiley

Social Security #: 3947

Signed Date: 01-16-2017

Signed:

FMCSA Notification of Driver Rights 15

TRUCK DRIVER TRAINING SCHOOL DISCLOSURE

ATTENDANCE AT A PARTICULAR TRUCK DRIVER TRAINING SCHOOL IS NOT A CONDITION OF EMPLOYMENT AS A PROFESSIONAL TRUCK DRIVER AT CRST By signing below, the undersigned student expressly acknowledges that attending a particular driver-training school is not a condition of employment with CRST Expedited, Inc. ("CRST"), and that the student may attend any accredited driver-training school he or she chooses. CRST will not consider an application for employment until the individual obtains a valid CDL. Once the individual obtains a valid CDL, the individual may apply for employment and CRST will consider the application regardless of whether the driver received training at a particular driver-training school.

Printed Name: Glenn B Wiley

Social Security #: 3947

Signed Date: 01-16-2017

Signed:

FMCSA Notification of Driver Rights 16

DISCLOSURE AND AUTHORIZATION FORMS

Disclosure Regarding Background Investigation

CRST Expedited, Inc. (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment. This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period.

HireRight Solutions, Inc. ("HireRight"), Explore Information Services, LLC ("Explore"), or another consumer reporting agency, will prepare or assemble the background reports for the Company. HireRight is located at and can be contacted by mail at 3349 Michelson Drive, Suite 150, Irvine, CA 92612; its phone number is 866-***-****; its email address is acyezi@r.postjobfree.com; and its website is hireright.com. Explore is located at and can be contacted by mail 2900 Lone Oak Parkway, Suite 140A, Eagan, MN 55121; its phone number is 800-***-****; its fax number is 651-***-****; its email address is acyezi@r.postjobfree.com; and its web site is exploredata.com.

The background reports may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker's compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.

This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; personal interviews with sources such as neighbors, friends and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated. Should the Company obtain a copy of your background reports, then you have the right to obtain a free copy of the background reports from HireRight or Explore or other consumer reporting agency within 60 days. You also have the right to dispute with HireRight or Explore or other consumer reporting agency the accuracy or completeness of any information in the background reports. A summary of your rights under the Fair Credit Reporting Act is also being provided to you. Additional state law notices have been provided to you.

Printed Name: Glenn B Wiley

Social Security #: 3947

Signed Date: 01-16-2017

Signed:

FMCSA Notification of Driver Rights 17

ADDITIONAL STATE LAW NOTICES

If you are a California, Maine, Massachusetts, Minnesota, New Jersey, New York or Washington State applicant, employee or contractor, please

Contact this candidate